Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0100X | Gastroenterologist | 179332-1 | NY |
NPI | 1003899261 |
---|---|
Provider Name | Dr. Bradley Sklar |
First Address | Utica, NY 13502-6313 |
Second Address | Utica, NY 13502-6313 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/11/2005 |
Last Update Date | 03/06/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01407836 | (05) | NY |
F51565 | (02) | NY |